title: Thoracic sympathectomy at the level of the fourth and fifth ribs for the treatment of axillary hyperhidrosis.
abstract: OBJECTIVE
  To describe the clinical results and the degree of satisfaction of patients submitted to thoracic sympathectomy at the level of the fourth and fifth ribs (R4-R5) for the treatment of axillary hyperhidrosis.
  
  
  METHODS
  We included 118 patients diagnosed with axillary hyperhidrosis and having undergone axillary sympathectomy at the R4-R5 level between March of 2003 and December of 2007 at the Paraná Federal University Hospital de Clínicas, located in the city of Curitiba, Brazil. All procedures were carried out by the same surgeon. Data regarding the resolution of axillary hyperhidrosis and the degree of patient satisfaction with the surgical outcome, as well as compensatory hyperhidrosis in the early and late postoperative periods (after 7 days and after 12 months, respectively), were collected.
  
  
  RESULTS
  Of the 118 patients evaluated, 99 (83.9%) and 81 (68.6%) showed complete resolution of the symptoms in the early and late postoperative periods, respectively. Compensatory hyperhidrosis occurred in 49 patients (41.5%) in the early postoperative period and in 77 (65.2%) in the late postoperative period. Of those 77, 55 (71.4%) categorized the compensatory hyperhidrosis as mild. In the early postoperative period, 110 patients (93.2%) were satisfied with the surgical results, and 104 (88.1%) remained so in the late postoperative period.
  
  
  CONCLUSIONS
  Sympathectomy at the R4-R5 level is efficient in the resolution of primary axillary hyperhidrosis. The degree of patient satisfaction with the long-term surgical results is high. Mild compensatory hyperhidrosis is the main side effect associated with this technique.
authors.affiliation: Department of Thoracic Surgery, Federal University of Paraná Hospital de Clínicas, Curitiba, Brazil.
authors.forename: Paulo César Buffara
authors.initials: PC
authors.lastname: Boscardim
authors.forename: Ramon Antunes de
authors.initials: RA
authors.lastname: Oliveira
authors.forename: Allan Augusto Ferrari Ramos de
authors.initials: AA
authors.lastname: Oliveira
authors.forename: Juliano Mendes de
authors.initials: JM
authors.lastname: Souza
authors.forename: Roberto Gomes de
authors.initials: RG
authors.lastname: Carvalho
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla; D015992:Body Mass Index; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome